Use of psychoactive agents in the treatment of sexual dysfunction

Sexual function can be subdivided into phases of sexual desire, penile erection, ejaculation and orgasm. Dysfunction of these processes is manifest as disorders that include hypoactive sexual desire, male erectile dysfunction, premature and retarded ejaculation, and anorgasmia, These disorders can be primary in aetiology or can be caused by a number of psychoactive drugs including, commonly, antidepressants. At present, sexual dysfunction is rarely treated with pharmacological agents. The usual approach consists of psychotherapy. However, in recent years, more interest has arisen in treating disorders of sexual function with psychopharmacological drugs, particularly sexual dysfunction that is the adverse effect of antidepressants. Clinical reports suggest that primary premature ejaculation can be successfully treated with clomipramine and selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors. At present, only a few oral medications have been shown to be useful in the treatment of erectile dysfunction (including yohimbine and trazodone), although these have not been developed specifically for this indication. The pharmacological treatment of primary retarded ejaculation and female primary anorgasmia still offers no efficacy-There are, on the other hand, a number of drugs available for treating the sexual adverse effects of antidepressant therapy. These appear to act either on the central or peripheral nervous system and include cyproheptadine, bethanechol, yohimbine, buspirone and some dopamine receptor agonists [amantadine, amfebutamone (bupropion), dexamphetamine and pemoline]. More methodologically correct clinical research is necessary to elucidate better treatments for sexual dysfunction.